1-10. BASIC DENTAL EXAMINATION SETUP
a. The Setup. The basic dental examination setup (figure 1-13) consists of a mouth mirror, cotton pliers, explorer, periodontal probe, cotton dispenser with cotton, Two by two inch gauze pads, and a saliva ejector. This equipment is used in almost every dental treatment procedure. The water and air syringes are frequently used to remove debris and fluids from tooth surfaces so that they may be examined more accurately. A good light source is also essential to adequate vision in performing any oral diagnostic procedures.
b. The Sterile Pack.
(1) Certain instruments are required for each type of dental procedure. In order to facilitate the work being done, these instruments can be prepared in advance. Possibly days, or even weeks, before the actual operation is performed, the dental assistant can wrap the proper instruments in a pack (usually paper or muslin) and autoclave them. These sterile packs can then be stored and used whenever necessary. This method will save both time and space in the dental clinic. The pack used most frequently contains the basic examination instruments, with the exception of the saliva ejector. These could be prepared long in advance since a basic examination is common procedure for all types of dental work. Remember, though, that the type of material in which the instruments are autoclaved determines how long they will remain sterile.
(2) The instruments found in the basic examination sterile pack is the explorer, (number 6, number 17, or number 23), the mouth mirror, the periodontal probe, cotton pliers, and 2x2-inch gauze pads.
Figure 1-13. Instruments and materials for basic examination.
1-13. MEDICAL HISTORIES
a. General. Any dental examination includes taking and recording the patient's medical history. The medical history may be brief or detailed, depending upon the findings and observations made during the examination. The history consists mainly of information pertinent to the conditions revealed during the examination and is obtained from the patient from questions asked by the dental officer. A medical history should be updated at every appointment.
b. Importance of Medical Histories. The following are four important functions of patient medical histories:
(1) Provide important information that assists the dental officer in arriving at a diagnosis.
(2) Provide information on conditions that might lead to complications during treatment procedures if not previously recognized.
(3) Establish good rapport with the patient.
(4) Provide a good opportunity for patient education.
c. Taking and Recording Histories. Pertinent information brought out while taking the patient's history should be recorded in writing. In taking a history, the dental officer often has an established routine, which he conscientiously follows so that no possible information is overlooked. He may take brief notes and later write the summary to be recorded or transcribed as part of the patient's record.
d. Ethical Aspects. Information given by the patient to the dental officer is confidential and is used to enhance professional care. The dental specialist will not reveal confidential information to any person not concerned with the patient's medical or dental health.
e. Medication. The dental officer, during an initial examination and before starting any dental treatment, routinely asks a patient if he is taking any medication. If so, a notation is made on the record as to the type and amount of drug being taken. Special considerations in providing dental treatment and in prescribing additional drugs will be determined from this information.
f. Medical Treatment. During a dental examination, the dental officer asks the patient if he is under medical treatment and, if so, for what particular condition. This will enable the dental officer to determine the best plan for dental treatment.
g. Systemic Conditions. There are a number of oral manifestations of systemic diseases, if discovered while taking the medical history, which must be considered carefully in planning and carrying out the course of treatment. Because of physical standards for active military duty, these conditions are not as common in the military community as in other segments of the population. Some of these conditions, including potential dangers and precautions to be taken, are as follows:
(1) Congestive heart failure. Patients with congestive heart failure have hearts that have been weakened to the extent that they can no longer fulfill the body's demands. A physician is usually consulted before oral surgery or other dental treatments are performed.
(2) Rheumatic heart disease. Rheumatic fever is a disease that may affect the valves of the heart. Heart valves that have been damaged (rheumatic heart disease) by rheumatic fever are susceptible to infections from bacteria, which may be forced into the bloodstream during extraction of teeth or other dental procedure. Should a patient with a history of rheumatic fever require dental care, the dental officer normally will consult the patient's physician and institute prophylactic antibiotic treatment before performing the indicated treatment.
(3) Coronary artery disease. Patients with coronary artery disease (disease of the arteries that supply blood to the heart) may experience pressure or pain in the chest called angina pectoris. Pressure or pain occurs when narrowing of the coronary arteries prevents adequate oxygen to the heart muscles. Attacks may be brought on by nervousness and physical or emotional stress. Patients with a known history of angina pectoris should be treated only after every precaution has been taken to minimize nervousness and stress. Usually a physician is consulted before these patients are treated. The patient who has angina pectoris usually carries his own supply of nitro- glycerin.
(4) High blood pressure (hypertension). The dental officer normally will consult the patient's physician before surgery or any extensive dental treatment on a patient with elevated blood pressure. Premedication, selection of the anesthetic agent, and the duration and nature of anticipated surgery or dental manipulation all require careful consideration.
(5) Diabetes mellitus. Diabetes is a systemic disease in which the body is unable to utilize sugars in the diet because of the lack of insulin in the system. Diabetes may be controlled by periodic injections of insulin, oral medication, or diet, depending on its severity. Periodontal disease is often associated with uncontrolled diabetes. Special consideration must be given in performing surgery or any dental treatment on diabetics because of their tendency to bleed easily and their high susceptibility to infections. The dental officer normally will not perform extractions on uncontrolled diabetics unless the patient's physician assumes responsibility and supportive measures have been employed.
(6) Hemophilia. Hemophilia is a rare hereditary condition appearing in males. In hemophilia, there is profuse bleeding due to an inadequate clotting mechanism resulting in prolonged uncontrollable bleeding, even from the slightest cut. Any necessary surgical procedures should be done only with the cooperation of the patient's physician to minimize and to control bleeding.
(7) Pernicious anemia. Pernicious anemia is a severe form of anemia characterized by lowering red blood cell count, weakness, and other forms of debilitation. One frequent early symptom is a painful, fiery red inflammation of the tip and sides of the tongues. The wearing of dentures or any other mild mechanical irritations cannot be tolerated by some patients with pernicious anemia.
(8) Allergy and hypersensitivity. Patients may be allergic or hypersensitive to any of a number of drugs or materials used in dentistry. The dental officer must take a thorough history, so that he may avoid the use of drugs and materials to which the patient may have an unfavorable reaction.
(9) Hyperthyroidism. Hyperthyroidism is a disease in which the thyroid gland is abnormally active and produces marked systemic effects. Among these effects are pronounced nervousness and emotional instability, cardiovascular changes, weakness, and other symptoms. Extensive or painful oral operations or the use of agents containing adrenalin is contraindicated in the active hyperthyroid cases. The patient's physician normally will be consulted before an oral operation is performed on the patient. The hyperthyroid patient on adequate medication can become a well-stabilized dental patient.
(10) Hepatitis B. Patients with active hepatitis, or who are carriers of the Hepatitis B virus, can infect the dentist, staff, and other patients. To reduce risk to everyone, strict barrier protection procedures must be enforced (masks, gloves, gowns, and protective eyewear) along with strict aseptic techniques. Hepatitis is a very debilitating disease and causes death in a small percentage of the cases. Therefore, it is recommended that all dental personnel receive the heptavax vaccine to eliminate risk of infection with the Hepatitis B virus.
(11) HIV Infection. Human Immunodeficiency Virus (HIV) infection, or AIDS as it was originally called, causes death by destroying the patient's immune system. More simply, the patient dies from an infection because the body's defense system does not work. This virus is very difficult to transmit from one person to another. A dental care provider cannot contract an HIV infection through daily contact at the workplace. The HIV infection enters the bloodstream by having sex with an infected person or by shooting drugs with a needle or syringe that has been used by an infected person. If you work on an HIV positive patient, the patient is many more times at risk than you are. The reason is the their immune system cannot easily control new and different infections. It is important, then, to have extremely strict aseptic procedures before, during, and after patient care. This reduces the risk to the HIV patient and the possibility of risk to other patients and the dental care providers.